Provider Demographics
NPI:1063444701
Name:MARCHESE TUMMINELLO, JENNIFER (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:MARCHESE TUMMINELLO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E RIDGEWOOD AVE
Mailing Address - Street 2:SUITE 2 B
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3866
Mailing Address - Country:US
Mailing Address - Phone:201-390-1800
Mailing Address - Fax:
Practice Address - Street 1:111 E RIDGEWOOD AVE
Practice Address - Street 2:SUITE 2 B
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3866
Practice Address - Country:US
Practice Address - Phone:201-390-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052120001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ427458OtherMEDICARE PTAN
NJQ46195Medicare UPIN